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Estimating stage-specific sensitivity for cancer screening tests.
Paul Pinsky1, Jane Lange2, Ruth Etzioni3
1Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA.
Journal of Medical Screening
|February 3, 2023
Summary
Estimating cancer screening sensitivity is crucial. Current methods for prospective and retrospective analysis are unreliable, particularly for early-stage cancers, requiring significant improvements for accurate assessment.
Area of Science:
- Oncology
- Biostatistics
- Medical Screening
Background:
- Accurate estimation of cancer screening sensitivity is vital for evaluating new modalities, especially for early-stage disease.
- Existing methods for approximating stage-specific sensitivity in asymptomatic populations (prospective and retrospective) have not been adequately validated.
Purpose of the Study:
- To explore the validity of current methods for estimating stage-specific sensitivity in prospective (active screening) and retrospective (stored specimens) scenarios.
- To assess the reliability of these methods through a simulation study using natural history models for lung and ovarian cancer.
Main Methods:
- Natural history models were fitted to lung and ovarian cancer screening data to estimate true stage-specific sensitivity (early/late).
- Simulations were conducted for prospective and retrospective scenarios using the fitted models.
- Prospective sensitivity was estimated as screen-detected cancers divided by screen-plus interval-detected cancers.
- Retrospective sensitivity was estimated based on cancers detected within specified time windows before clinical diagnosis.
Main Results:
- For lung cancer, true early-stage sensitivity was 47% (late: 63%). Prospective simulations yielded estimated sensitivities of 81% (early) vs. 62% (late).
- Retrospective simulations showed lower estimates: 35%/57% (1-year window) and 27%/49% (2-year window) for early/late stages.
- Ovarian cancer results mirrored lung cancer, with estimated prospective sensitivity (84%) significantly exceeding true early-stage sensitivity (25%).
Conclusions:
- Current methods for approximating stage-specific sensitivity in both prospective and retrospective cancer screening scenarios are unsatisfactory.
- Significant improvements are required to ensure the reliability of these methods before they can be widely adopted.
- The discrepancy between estimated and true sensitivity highlights the need for more robust validation techniques in cancer screening evaluation.
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